Yoğun Bakımdaki Kritik Hastalarda Akut Böbrek Hasarında Renal Replasman Tedavisi Kararı ve Zamanlaması

Yoğun bakım ünitelerinde YBÜ takip edilen kritik hastalarda gelişen akut böbrek hasarı ABH önemli bir morbidite ve mortalite nedenidir. Bu hastalarda yapılan renal replasman tedavilerinin RRT başlatılmasında hangi kriterlerin kullanılacağı ve tedavinin ne zaman başlatılacağı soruları net olarak cevaplanmış değildir. Bu derlemede YBÜ’de RRT başlangıcını belirleyen faktörler incelendi. Ayrıca hastaların üre-kreatinin seviyeleri, idrar çıkışı-sıvı yükü, YBÜ yatışı ile RRT başlangıcı arasında geçen süre, prognostik faktörler ve bazı belirteçlere göre başlatılan erken ve geç RRT çalışmaları incelendi. Sonuçta YBÜ’de kritik hastalarda RRT başlangıcını belirleyen kriterler ve bu kriterlerin eşik değerlerinin kişiselleştirilmesi gerektiği düşünüld

Pulmonary Involvement of Diffuse Large B-cell Lymphoma with Cavitary Lesions

Abstract Diffuse large B-cell lymphoma (DLBCL) is the most common type of extranodal lymphoma. Typically disease occurs fastly growing nodal or extranodal masses with systemic symptoms. Pulmonary involvement may also occur in DLBCL. Here we present a DLBCL with cavitary lesions in the lung. A 59-year-old male was diagnosed with DLBCL through an endoscopic gastric biopsy that was performed 1.5 years ago. After six course of R-CHOP chemotherapy, the relaps of disease was confirmed with mediastinoscopy. Despite two courses of RICE chemotherapy and one course of R-BAB therapies, the patient was admitted to the intensive care unit with shortness of breath and tachypnea. Thorax computed tomography showed a mass lesion that enclosed and narrowed the right major bronchus and multiple lesions with cavitation. The infections were excluded with bronchoscopy. The patient received pulse steroid therapy, radiotherapy and three courses of Hyper-CVAD chemotherapy. In the control thorax CT, cavitary lesions got smaller, respiratory insufficiency of patient improved. When pulmonary cavitary lesions are observed in patients under follow-up with the diagnosis of lymphoma, the pulmonary involvement of lymphoma should also be considered in addition to the infectious agents

Mortality Risk Factors of Acinetobacter baumannii Infections in a Medical Intensive Care Unit: A 2-Year Survey

Introduction: Acinetobacter baumannii is considered to be a nosocomial pathogen gradually becoming more important around the world and in Turkey, particularly for patients in intensive care units (ICUs). In this study, we endeavored to overview the general characteristics of the inpatients who were treated in our ICU and diagnosed with A. baumannii infection, and particularly to determine risk factors of patients with mortal A. baumannii infection. Materials and Methods: This retrospective study was conducted in the nine-bed medical ICU of a 900-bed tertiary university hospital and was designed to include a two-year period (April 2007-April 2009). Characteristics of the patients before their admission to ICU and during their stay were examined, and factors related to A. baumannii infection together with factors affecting mortality were determined. Results: One hundred and twenty-nine patients were included in the study. Mean age of the patients was 63.05 (± 17.28) years, and 59.7% of the patients were males. The majority of the patients were admitted to the ICU from both emergency service and internal medicine clinics due to respiratory failure or sepsis. Forty-seven point three percent of patients (47.3%) were immunosuppressive. One hundred and sixty-three A. baumannii isolates were identified in 129 patients. A. baumannii was mostly isolated from tracheal aspirate cultures (70.5%) followed by bloodstream or central catheter cultures (16%). On average, 89% of isolates were resistant to ciprofloxacin and 94.5% to imipenem. Seventy-three percent of patients (n= 108) were diagnosed as pneumonia or ventilator-associated pneumonia (VAP), 15% (n= 22) as bloodstream infection, 8.7% (n= 13) as skin/soft tissue infection, and 3.3% (n= 5) as urinary tract infection. Ninety-eight patients (76%) who were infected by A. baumannii died. Factors affecting mortality according to univariate analysis were listed roughly in terms of Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, length of hospital stay before ICU, the clinic from which the patient was transferred to the ICU, applied invasive procedures (mechanical ventilation, catheters, dialysis, etc.), complications in the ICU, and antibiotics used previously. According to multivariate analysis, the most significant risk factors for mortality were application of invasive mechanical ventilation, sepsis in the ICU and admission from internal medicine clinics. Conclusion: Resistant A. baumannii infections are among the major medical challenges worldwide, in Turkey, and in our ICU. The mortality rate is high, and different risk factors affect the mortality rate in A. baumannii infections. According to our study, application of invasive mechanical ventilation, sepsis in the ICU and admission from internal medicine clinics were the major risk factors for mortality in our A. baumannii-infected ICU patients

Submassive pulmonary thromboembolism as a first sign of occult adenocarcinoma

Venous thromboembolism is one of the most common complications of cancer, which also contributes to mortality in cancer patients. Venous thromboembolism can be observed as the first manifestation of occult cancer. We present the case of a 54-year-old woman with deep vein thromboembolism and pulmonary embolism as the first signs of cancer, who was subsequently diagnosed with disseminated adenocarcinoma, most likely originated from the pancreatico-biliary system

Importance of RIFLE (Risk, Injury, Failure, Loss, and End-Stage Renal Failure) and AKIN (Acute Kidney Injury Network) in Hemodialysis Initiation and Intensive Care Unit Mortality.

Our study evaluated the differences between early and late hemodialysis (HD) initiation in the intensive care unit (ICU) according to the RIFLE (Risk, Injury, Failure, Loss, and End-stage renal failure) and AKIN (Acute Kidney Injury Network) classifications. On the assumption that early initiation of HD in critical patients according to the RIFLE and AKIN criteria decreases mortality, we retrospectively evaluated the medical records of 68 patients in our medical ICU and divided the patients into 2 groups: Those undergoing HD in no risk, risk, or injury stage according to RIFLE and in stage 0, I, or II according to AKIN were defined as early HD and those in failure stage according to RIFLE and in stage III according to AKIN were defined as late HD. The median age of the patients was 66.5 years, and 56.5% were male. HD was started in 25% and 39.7% of the patients in the early stage in the RIFLE and AKIN classification, respectively. According to RIFLE, HD was started in 61.5% of the surviving patients in the early stage; this rate was 16.4% in the deceased patients (P=0.001). HD was commenced in 69.2% of the surviving patients in AKIN stages 0, I, and II and in 32.7% of the deceased patients (P=0.026). Sepsis (61.5% vs. 94.5%; P=0.001) and mechanical ventilation (30.8% vs. 87.3%; P<0.001) during HD increased ICU mortality, whereas HD initiation in the early stages according to RIFLE decreased ICU mortality (61.5% vs. 16.4%; P=0.001). In conclusion, in critically ill patients, HD initiation in the early stages according to the RIFLE classification decreased our ICU mortality

Bacterial Meningitis in Adults: A Review of 106 Episodes

In this study, we retrospectively evaluated 106 meningitis cases, of which 74 were nontuberculous bacterial meningitis (NTBM), 32 were tuberculous meningitis (TM) in a period of 12 years between 1985 and 1997. Among 74 episodes of NTBM, the most common pathogens were S. pneumoniae (32%) and N. meningitidis (15%). The mortality rate was 28% for NTBM while 35% for TM (p > 0.05). In NTBM cases leukocytosis, high erythrocyte sedimentation rate, tachypnea, low diastolic blood pressure and obtunded mental state on admission were significant prognostic factors, while mental status change and leukocytosis were only significant prognostic factors in TM cases. Dexamethasone was added to the therapy in 40% of all cases. Dexamethasone had no effect on mortality and sequelae either in TM or NTBM